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    <title>In the Memory of Cancer Victims - Submit Details Regarding Dear Person </title>
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                    <td style="padding-left:40px"><a href="index.html">Main</a> &nbsp; &nbsp; &nbsp;<b>Add Your Relative</b> &nbsp; &nbsp; &nbsp;<a href="about.html">About</a></td>
                    <td style="padding-right:40px" align="right">English <a href="submit_person_ru.html">Русский</a></td>
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                <h2>Submit Details Regarding Dear Person</h2>
                In order to add your dear person to the internet project <a href="http://www.frenkel.ca">In the Memory of Cancer Victims</a>, please submit the form below. Only fields marked with star (*) are mandatory - these are your first name, email address and full name of your dear person. You can find <a href="http://code.google.com/p/fight-cancer/wiki/PrivacyPolicy">here</a> which measures are taken in order to protect your email address. After you fill the form, click the button below. A new window should open in order to send details by email to fight-cancer@frenkel.ca. You can also attach a picture of your dear person to the email.

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                After we receive your email:
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                  <li>We will send you confirmation with received details. If you would like to make any changes, please send them to fight-cancer@frenkel.ca.</li>
                  <li>We will validate submitted details. If there will be any comments, we will contact you by email.</li>
                  <li>After publishing the submitted details on internet project <a href="http://www.frenkel.ca">In the Memory of Cancer Victims</a>, we will send you a notification.</li>
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                      <td>Your first name (will be used for correspondence):</td>
                      <td><input type="text" id="submitter.firstname" name="submitter.firstname"/>*</td>
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                      <td>Email address:</td>
                      <td><input type="text" id="email" name="email"/>*</td>
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                      <td>Full name of your dear person, for example <i>Anna Kur (nee Taub)</i>:</td>
                      <td><input type="text" name="fullname" id="fullname" />*</td>
                    </tr>

                    <tr>
                      <td>Date of birth:</td>
                      <td>Day:
                        <select name="birthday" id="birthday">
                          <option value=""></option>
                          <option value="01">01</option>
                          <option value="02">02</option>
                          <option value="03">03</option>
                          <option value="04">04</option>
                          <option value="05">05</option>
                          <option value="06">06</option>
                          <option value="07">07</option>
                          <option value="08">08</option>
                          <option value="09">09</option>
                          <option value="10">10</option>
                          <option value="11">11</option>
                          <option value="12">12</option>
                          <option value="13">13</option>
                          <option value="14">14</option>
                          <option value="15">15</option>
                          <option value="16">16</option>
                          <option value="17">17</option>
                          <option value="18">17</option>
                          <option value="18">18</option>
                          <option value="19">19</option>
                          <option value="20">20</option>
                          <option value="21">21</option>
                          <option value="22">22</option>
                          <option value="23">23</option>
                          <option value="24">24</option>
                          <option value="25">25</option>
                          <option value="26">26</option>
                          <option value="27">27</option>
                          <option value="28">28</option>
                          <option value="29">29</option>
                          <option value="30">30</option>
                          <option value="31">31</option>
                        </select>
                        Month:
                        <select name="birthmonth" id="birthmonth">
                          <option value=""></option>
                          <option value="01">Январь</option>
                          <option value="02">Февраль</option>
                          <option value="03">Март</option>
                          <option value="04">Апрель</option>
                          <option value="05">Май</option>
                          <option value="06">Июнь</option>
                          <option value="07">Июль</option>
                          <option value="08">Август</option>
                          <option value="09">Сентябрь</option>
                          <option value="10">Октябрь</option>
                          <option value="11">Ноябрь</option>
                          <option value="12">Декабрь</option>
                        </select>
                        Year: <input type="text" name="birthyear" id="birthyear" />
                      </td>
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                      <td>Place of birth:</td>
                      <td><input type="text" name="birthplace" id="birthplace" /></td>
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                      <td>Date of death:</td>
                      <td>Day:
                        <select name="deathday" id="deathday">
                          <option value=""></option>
                          <option value="01">01</option>
                          <option value="02">02</option>
                          <option value="03">03</option>
                          <option value="04">04</option>
                          <option value="05">05</option>
                          <option value="06">06</option>
                          <option value="07">07</option>
                          <option value="08">08</option>
                          <option value="09">09</option>
                          <option value="10">10</option>
                          <option value="11">11</option>
                          <option value="12">12</option>
                          <option value="13">13</option>
                          <option value="14">14</option>
                          <option value="15">15</option>
                          <option value="16">16</option>
                          <option value="17">17</option>
                          <option value="18">17</option>
                          <option value="18">18</option>
                          <option value="19">19</option>
                          <option value="20">20</option>
                          <option value="21">21</option>
                          <option value="22">22</option>
                          <option value="23">23</option>
                          <option value="24">24</option>
                          <option value="25">25</option>
                          <option value="26">26</option>
                          <option value="27">27</option>
                          <option value="28">28</option>
                          <option value="29">29</option>
                          <option value="30">30</option>
                          <option value="31">31</option>
                        </select>
                        Month:
                        <select name="deathmonth" id="deathmonth">
                          <option value=""></option>
                          <option value="01">Январь</option>
                          <option value="02">Февраль</option>
                          <option value="03">Март</option>
                          <option value="04">Апрель</option>
                          <option value="05">Май</option>
                          <option value="06">Июнь</option>
                          <option value="07">Июль</option>
                          <option value="08">Август</option>
                          <option value="09">Сентябрь</option>
                          <option value="10">Октябрь</option>
                          <option value="11">Ноябрь</option>
                          <option value="12">Декабрь</option>
                        </select>
                        Year: <input type="text" name="deathyear" id="deathyear" />
                      </td>
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                      <td>Place of death:</td>
                      <td><input type="text" name="deathplace" id="deathplace" /></td>
                    </tr>

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                      <td>Diagnosis:</td>
                      <td><input type="text" name="diagnosis" id="diagnosis" value="Cancer"/></td>
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                        I confirm that the most close relative of the deceased person <br/>
                        submitted in this form agrees to the publication of submitted<br/> 
                        here details on the internet project 
                        <a href="http://www.frenkel.ca">In the Memory of Cancer Victims</a>
                      </td>
                      <td>
                        <input type="radio" name="agree" id="relative-agrees-to-publish" /> Agrees<br />
                        <input type="radio" name="agree" id="relative-does-not-agree-to-publish" checked="true"/> Does not agree</td>
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                      <td>About the person:</td>
                      <td><textarea name="about" id="about" cols="60" rows="5"></textarea></td>
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                      <td>Signature for the section "About the person":<br/>If there are words like <i>I</i> or <i>We</i> in the section "About the person", then you should fill this section</td>
                      <td><textarea name="about-signature" id="about-signature" cols="60" rows="2"></textarea></td>
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                  <p/>
                  After you complete the form above, click this <button type="button" onclick="processApplication('en')">button</button>. If for some reason a window for sending the form does not appear, then copy&amp;paste the text below to fight-cancer@frenkel.ca. Do not forget to attach a picture.

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                  <textarea id="message-xml" name="message-xml" cols="120" rows="50" readonly="true">  </textarea>
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